Crypt glandular infection theory is accepted as an explanation of anal fistula's major cause. However, the pathogenesis of an anal fistula in Crohn's disease is different from that of a conventional anal fistula because a Crohn's anal fistula is caused by ulceration which, in turn, is caused by transmural inflammation of the rectal wall due to Crohn's disease. The difficulty with operating on anal fistulas in Crohn's disease lies in the fact that healing of the wound is inhibited because of continuous inflammation of the anorectal tissue due to Crohn's disease. Hence, there is a high possibility of incontinence due to sphincter muscle injury. Especially, because almost all Crohn's disease patients have frequent defecation and diarrhea, the patients will suffer more if incontinence occurs. Nowadays, even with increased understanding of the etiology of Crohn's disease, new medications, and aggressive surgical approaches, the result of treatment is still not satisfactory. Recently, since Korean eating habits have changed to include more western-style food in the diet, inflammatory bowel disease, such as Crohn's disease, is expected to increase. Consequently, the number of cases of anal fistulas in Crohn's disease is also expected to increase. The authors reviewed 20 confirmed cases of anal fistulas in Crohn's disease, which were treated from January 1993 to December 1995 at Song-Do Colorectal Hospital. The results are as follows: 1) Anal fistulas in Crohn's disease were present in 20(0.6%) of the 3378 cases of anal fistulas treated during the time period considered. 2) The male to female ratio for these 20 cases was 2: 1, and the most Prevalent age group was the 3rd decade, followed by the 2nd decade, the 4th decade, and the 5th decade in that order. 3) Three cases of anal fistulas whose origins could be explained by crypt glandular infection theory and which did not involve the rectum healed, although the healing was delayed. 4) Seventeen cases of anal fistulas whose origins could not be explained by crypt glandular infection theory and which involved the rectum did not heal after the operation. he results of the study show that anal fistulas whose origins can be explanined by crypt glandular infection theory and which do not involve the rectum can be cured by conventional fistula surgery. However, perirectal fistulas whose origins can not be explained by crypt glandular infection theory and which involve the rectum do not heal. Because there is the possibility of incontinence after a conventional operation, it is suggested that, in the cases of perirectal fistulas in Crohn's disease, better results, although not completely satisfactory, can be obtained by long-term seton drainage and diversion colostomy.
Colostomy ; Crohn Disease* ; Defecation ; Diarrhea ; Diet ; Drainage ; Eating ; Female ; Fistula ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Male ; Rectal Fistula* ; Rectum ; Ulcer ; Wounds and Injuries

An external thrombotic hemorrhoid is a very painful disease with a high incidence rate. The chief complaints encountered by the surgeon are protrusion and pain. However, because the spontaneous healing rate is very high, there is no consensus on whether conservative management or surgery is a more effective treatment policy. In an attempt to resolve this problem, we performed a clinical analysis of fifty patients with external thrombotic hemorrhoids who were treated by conservative management at Song-Do Colorectal Hospital from October 1996 to December 1996. We recorded the time required for the protrusion and the pain to disappear and performed manometry to check the sphincter pressure and tissue pathology to determine the pathogenesis of the external thrombotic hemorrhoid. The results are as follows: 1) Based on pathology, the cause of the external thrombotic hemorrhoids was venous thrombosis due to venous stasis, not a hematoma due to venous rupture. 2) Manometry showed that the resting sphincter pressure and the squeezing sphincter pressure for the patients with external thrombotic hemorrhoids was higher than those of the control group, which was the reason for the venous stasis. In conclusion, because an external thrombotic hemorrhoid is just a thrombosis due to venous stasis, the thrombosis can be improved by using methods such as a warm sitz bath and analgesics to decrease the sphincter pressure. Hence, conservative management should be the preferred treatment in almost all cases.
Analgesics ; Baths ; Consensus ; Hematoma ; Hemorrhoids ; Humans ; Incidence ; Manometry ; Pathology ; Rupture ; Thrombosis ; Venous Thrombosis

Colitis Cystica Profunda(CCP) is an uncommon disease in Korea, and little knowledge exists about CCP, including knowledge about its incidence and prevalence. However, it may be speculated that the disease will be diagnosed more often due to advancement in diagnostic tool and growing interest. CCP is essentially the same disorder as Solitary Rectal Ulcer Syndrome(SRUS), but it has been reported separately because of its external appearances such as broad shaped polyps or nodules. Both CCP and SRUS are called MPS. Of importance is that a submucosal-cyst-containing lesion needs to be differentiated from mucus- producing adenocarcinoma. This differentiation is obvious from the CCP histologic features, such as fibromuscular obliteration of lamina propria and submucosal cysts. In light of these facts, it is important to obtain a sufficient biopsy specimen to examine accurately. It is not uncommon for CCP to be accampanied by rectal prolapse or incomplete intussusception, so diagnostic approaches of these associated disorders should be done at the same time. The authors have recently experienced one case of CCP associated with rectal prolapse. The case was treated effectively and is reported in this paper along with a review of the literature on this subject.
Adenocarcinoma ; Biopsy ; Colitis* ; Incidence ; Intussusception ; Korea ; Mucous Membrane ; Polyps ; Prevalence ; Rectal Prolapse ; Ulcer

Ischemic colitis is an uncommon disease in Korea, but nowadays, the incidence of this disease is increasing in Korea. The reason is that the number of old patients is increasing and colonoscopic diagnosis is performed more frequently. It is especially important to differentiate it from other inflammatory bowel disease, such as infectious colitis, ulcerative colitis, Crohn's disease, and drug-induced colitis, because ischemic colitis is similar to other inflammatory bowel disease in symptoms and colonoscopic findings. However, the authors were able to differentiate ischemic colitis from other inflammatory bowel disease by close examination of a patient's history, microscopic examination and culture studies of the bacteria in the stool, and close observation of the changes in the colonoscopic findings with time. We experienced six cases of ischemic colitis and report them along with a brief review of the literature.
Bacteria ; Colitis ; Colitis, Ischemic* ; Colitis, Ulcerative ; Crohn Disease ; Diagnosis ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Korea

BACKGROUND: Even though lasers have been used in hemorrhoidectomies, there has been much debate about their effect. PURPOSE: A prospective randomized study was performed comparing the efficacy of a Nd:YAG laser with that of scalpel excision when performing a ligation excision, semi-closed hemorrhoidectomy. METHODS: Sixty patients, who had more than three piles, with 3rd or 4th grade hemorrhoids, were enrolled into this study. Hemorrhoidectomies were performed under low spinal anesthesia. The ligation excision, semi-closed hemorrhoidectomy technique was used. Data evaluated included age, sex, operative time, postoperative pain scores, postoperative analgesic requirement, wound-healing time, and postoperative complications. Of the sixty patients enrolled into this study, 30 received laser excision and the other 30 scalpel excision. RESULTS: There were no significant differences between the two groups, except for operative time (laser, 34.6 8.4 min; scalpel, 24.1 4.8 min). Postoperative complications, such as urinary retention, fecal impaction, skin tags, and postoperative fissure, were more common in the laser group. CONCLUSIONS: A hemorrhoidectomy using a Nd:YAG laser takes longer than a conventional hemorrhoidectomy and neither reduces the postoperative pain nor shortens the wound-healing time. For achieving an effective treatment in hemorrhoids by using lasers, improved laser instruments are required, along with more detailed study of lasers and their effects.
Anesthesia, Spinal ; Fecal Impaction ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Lasers, Solid-State ; Ligation ; Operative Time ; Pain, Postoperative ; Postoperative Complications ; Prospective Studies ; Skin ; Urinary Retention

Lymphoid polyp is a rare disease in the colorectal area. It occurs commonly in the rectum. It is a nonepithelial benign tumor. Because of the benignancy of its nature, it has other names as well, such as benign lymphoma or rectal tonsil. A lymphoid polyp can be differentiated from a malignant lymphoma by the proliferation of normal lymphoid tissue which has a prominent follicular pattern and a clearly defined germinal center. A lymphoid polyp can regress spontaneousely without any treatment. There is no recurrence or malignant transformation. Recently, the authors experienced a case of lymphoid polyp in the rectum. We report a case of lymphoid polyp in the rectum diagnosed by piecemeal polypectomy.
Germinal Center ; Lymphoid Tissue ; Lymphoma ; Palatine Tonsil ; Polyps* ; Rare Diseases ; Rectum* ; Recurrence

Lymphoid polyp is a rare disease in the colorectal area. It occurs commonly in the rectum. It is a nonepithelial benign tumor. Because of the benignancy of its nature, it has other names as well, such as benign lymphoma or rectal tonsil. A lymphoid polyp can be differentiated from a malignant lymphoma by the proliferation of normal lymphoid tissue which has a prominent follicular pattern and a clearly defined germinal center. A lymphoid polyp can regress spontaneousely without any treatment. There is no recurrence or malignant transformation. Recently, the authors experienced a case of lymphoid polyp in the rectum. We report a case of lymphoid polyp in the rectum diagnosed by piecemeal polypectomy.
Germinal Center ; Lymphoid Tissue ; Lymphoma ; Palatine Tonsil ; Polyps* ; Rare Diseases ; Rectum* ; Recurrence

BACKGROUND/AIMS: Many endoscopists in Korea lack an understanding of laterally spreading, or creeping tumors(LSTs) which characteristically grow laterally, as opposed to other polypoid lesions, and which show superficially elevated lesions. An LST is similar in color to the adjacent normal mucosa, so it is difficult to recognize, but it can be detected by chromoscopy. When it grows to over 2-3 cm in its largest diameter, it can have malignant foci. It is important not to overlook the lesion and to remove it in a timely manner. METHODS: The authors experienced 9 cases of LSTs from Jan. 1996 to Jan. 1997. We reviewed those 9 cases clinically, endoscopically, and pathologically, and tried to establish the diagnostic and therapeutic key points. RESULTS: The most common age group was the fifth decade. The male-to-female ratio was 5:4. Four cases were asymptomatic, and lower abdominal pain and rectal bleeding were seen in 2 cases respectively. The rectum and the sigmoid colon were the most commonly involved sites showing 88.9% (8/9). Granular-type(nodule-aggregating-type) LSTs were seen in 4 cases and nongranular types(non-noodule-aggregating type) in 5 cases. 66.7%(6/9) were larger than 2 cm in the largest diameter. A tubular adenoma was seen in each of 5 cases; among them, 1 case had cellular atypia and another case revealed a submucosal(sm) carcinoma. Two granular types with large nodules had mucosal carcinomas. The sm carcinoma was a nongranular type. Endoscopically, redness was observed in 66.7%(6/9) of the cases and depression in 33.3%(3/9). The sm carcinoma had both redness and depression. Three cases underwent endoscopic piecemeal mucosal resection(EPMR) and the other 3 cases underwent endoscopic mucosal resection (EMR). A low anterior resection was performed on one patient; there was no lymph node metastasis. CONCLUSIONS: The characteristics of LSTs are important in their diagnosis and management. Nongranular-type LSTs are not uncommon, despite the difficulty in recognizing them by endoscopy. Pathologically, LSTs, in general, are tubular or tubulovillous adenomas. When they are over 2 cm in their largest diameter, they are likely to have malignancies. Giant nodule, redness and depression are important features indicating malignancy, especially an sm carcinoma. An EPMR or an EMR is the main treatment option, but depending on the depth of invasion, surgical resection may need to be considered.
Abdominal Pain ; Adenoma ; Colon, Sigmoid ; Depression ; Diagnosis ; Endoscopy ; Hemorrhage ; Humans ; Korea ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Rectum

BACKGROUND: This study was undertaken to review cases of juvenile polyps with respect to clinical and endoscopic features. METHODS: Of the 544 cases of colonoseopic polypectomies performed from Jan. 1 to Jan. 1997, 14 cases(2.6%) involved juvenile poiyps. Those 14 cases were analyzed with special consideration given to colonoscopic aspects. RESULTS: The most common age groups were the fifth and the sixth decades, comprising 50%. There were two children below 10 years of age. Males were predominant in the ratio of 1.3:1. Rectal bleeding was the most common symptom, and 4 cases were asymptomatic. Mediumsized(6~10 mm) polyps were the most common, 7 eases(50%), and large(> 1 cm) polyps were the next most common, 5 cases(35.7%). The first predilection of site was the rectum, 8 cases(57.1%); the second was the sigmoid colon with 5 cases(35.7%). Grossly, pedunculated polyps were the largest in number, accountieg for 64.3% of the cases; the others were all subpedunculated. In 9 cases(64.3%), the preoperative macroscopic diagnoses were consistent with the final diagnoses; in the other cases, the polyps were initially diagnosed as being adenomatous. Adenomatous and inflammatory polyps were associated with 3 cases, who were all men. White spots were noticed around the polyp base in 4 cases (28.6%); the clinical significance of those should be investigated further. All 14 patients underwent polypectomy by endoscopic snare resection without any complications. CONCLUSIONS: Colonoscopy should be the main tool for diagnosis and treatment of juvenile polyps. Juveoile polyps should be taken into account in cases of rectal bleeding and need to be differentiated from adenomatous polyps. Endoscopic polypectomy is an adequate procedure for the treatment of a solitary juvenile paiyp.
Adenomatous Polyps ; Child ; Colon, Sigmoid ; Colonoscopy ; Dental Caries ; Diagnosis ; Hemorrhage ; Humans ; Male ; Polyps* ; Rectum ; SNARE Proteins

Intersphincteric fistulas are the most prevalent fistulas encountered by a surgeon. In general, there are two surgical methods for treating intersphincteric fistulas: fistulotomy and fistulectomy. The advantage of a fistulotomy is less sphincter muscle destruction; the disadvantage is a higher recurrence rate. The advantage of a fistulectomy is a lower recurrence rate; the disadvantage is more sphincter muscle destruction and a higher flatus incontinence rate. Because of the disadvantages with both surgical methods, the authors have developed a new method for treating intersphincteric fistulas. The new method is a fistulectomy with seton. A fistulectomy with seton is a seton tightening of the remaining internal sphincter and subcutaneous external sphincter after coring out of the fistula tract. The advantages of this method are a lower recurrence rate due to complete removal of the fistula and a lower flatus incontinence rate due to the seton slowly cutting the remaining sphincter muscle. For that reason, the authors submit that fistulectomy with seton is the most effective operation method for treating intersphincteric fistulas, especially because fistulectomy with seton has many advantages such as a lower recurrence rate, a lower flatus incontinence rate, and less anal deformity.
Congenital Abnormalities ; Fistula* ; Flatulence ; Recurrence